Provider Demographics
NPI:1487857066
Name:WELLS, ANDREA J (MFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:WELLS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-0365
Mailing Address - Country:US
Mailing Address - Phone:831-425-3369
Mailing Address - Fax:
Practice Address - Street 1:740 FRONT ST STE 340
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4561
Practice Address - Country:US
Practice Address - Phone:831-425-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 33997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942372123OtherBHCI GROUP PROVIDER #